July 29, 2008

The same folks whose multimillion dollar brought you solid evidence that the low fat diet does not reduce heart disease have just analyzed their data and found that eating a low fat diet has no impact on preventing diabetes.

The Women's Health Initiative Study lasted 12 years and involved 48,835 postmenopausal women aged 50 to 79 years. Women were randomly assigned to a usual-diet comparison group (n = 29 294 [60.0%]) or an intervention group with a 20% low-fat dietary pattern with increased vegetables, fruits, and grains.

Here is the finding: "Weight loss occurred in the intervention group, with a difference between intervention and comparison groups of 1.9 kg [4 lbs] after 7.5 years (P < .001). Subgroup analysis suggested that greater decreases in percentage of energy from total fat reduced diabetes risk (P for trend = .04), which was not statistically significant after adjusting for weight loss." [emphasis mine]

What this means is that whatever tiny difference they found in the incidence of diabetes between the low fat diet group and the group eating a high carb, high fat "eat what you want" diet disappeared when they adjusted their data to take into account weight loss.

People who lost a bit of weight over this period had less diabetes, no matter how they lost the weight.

In fact, we know now that low carb diets produce more sustainable weight loss than do low fat diets. That has been shown in quite a few studies, the most recent of which is the Israeli study that found that a barely-low carb diet (one that was 40% carbohydrate, or 200 grams a day for a person eating 2000 calories a day) produced more weight loss than the low fat diet.

So if weight loss alone heads off diabetes, the low carb diet would be a much better choice. Of course, the low carb diet (particularly one that is truly low carb, which is not really the case with this Israeli study) prevents diabetes not only by causing weight loss, but by lowering blood sugar to normal levels in people who are pre-diabetic, and by doing this, it prevents the glucose toxicity: the poisoning of beta cells by high post-meal blood sugars, which pushes pre- into actual diabetes.

Sadly, though, the hugely funded WHI study was designed by people who were so certain they would see huge gains from the low fat diet that they did not include an arm that examined other diet strategies. The WHI only compared the low fat/high carb diet with the high fat/high carb diet.

It is worth noting that the Israeli study did not find a significant impact on the development of diabetes in the group of mostly men they studied who were eating a Kosher 40% carb diet. This does not surprise me because these men were eating 200 grams of carbohydrate for each 2000 calories they consumed.

That works out to almost 60 grams per meal--equivalent to a bagel per meal--which would be enough to raise blood sugar damagingly high after every meal for anyone who had any impairment in blood sugar metabolism.

In fact, how this diet could be considered a "low carb" diet escapes me. I would not consider a diet to be low carb unless the carb intake was at most 20% of all calories, or 100 grams a day in a 2000 calorie a day diet, which feedback from a lot of people with diabetes who control their blood sugar using carbohydrate restriction suggests is close to the upward limit of carbs most people can eat and maintain control.

But still, you'd think that the fact that the WHI data show that the low fat diet had no impact on either heart disease or diabetes when compared to the "all crap all the time" typical diet would be the last nail in the coffin of the argument that people with diabetes should cut fat rather than carbs from their diet.

Sadly, it isn't. The American Heart Association and the American Diabetes Association and are funded almost entirely by the drug and device companies and medical groups who earn huge profits only as long people continue to have the diseases these organizations are supposed to be fighting. So as soon as they were published, the AHA denounced the findings of the Israeli study--as tepid as they were, despite the clear cut proof that study gave that the cardiovascular risk profile of people eating a barely low carb diet improved over 2 years compared to those eating the low fat diet.

The ADA is almost certain to ignore the WHI data and say that "more study needs to be done" though the fact is that this was the single largest study of nutrition and health ever funded.

In fact, you can already see how this latest WHI finding was either a) ignored or b) spun by the mainstream media who report it. I've seen at least one report (based on the same abstract you saw at the head of this post) that touted the statistically insignificant difference between the low fat and non-low fat groups as implying that the low fat diet prevented diabetes, when the words "statistically insignificant" mean that in fact the difference in diabetes incidence between the two groups is meaningless.

July 23, 2008

I wish the food scientists at my alma mater, the University of Massachusetts, would stop taking food industry money to come up with news stories that promote their sponsor's products in ways that lead to more amputation, kidney failure, blindness and cardiac death. But they have done it again.

This week's horror study is the one that hit the news wires claiming that brown sugar, date sugar and corn syrup provide important health benefits for people with Type 2 diabetes. The story showed up in my local newspaper a few days ago, and I almost blogged about it then, but I had hoped that it appeared because the researcher was local and did not want to give it any more attention than it had already got.

But sadly, today's issue of Diabetes in Control picked up on the story and then it appeared in Medical News Today so it's clear that the sugar industry PR machine has been hard at work spreading the message that you should add more sugar to your diabetes health regimen. So let's look at what they found and why their conclusions are so flawed.

Here's the gist of the press release the sugar industry PR machine has gotten picked up in my newspaper and the internet health press: This version is from Medical News Today:

The press release then describes the UMASS study headed by Kalidas Shetty writing, "Many sweeteners contained significant amounts of antioxidants, which have the potential to control diabetes-linked high blood pressure and heart disease,' says Shetty, who adds that these were in vitro laboratory studies performed outside of living organisms. 'Several types of sweeteners also showed an interesting potential to inhibit the action of a key enzyme related to Type 2 diabetes, which is also the target of drugs used to treat this condition.'"

In short, this study suggests it's time for us folks with diabetes to start treating our disease with sugar!

But what did these researchers really find? They found minute amounts of antioxidants in brown sugar and date sugar. From this they drew the astonishing conclusion that since high blood sugars cause oxidation, people with diabetes would benefit from eating sugars that contain tiny amounts of antioxidants.

It gets worse. The next thing they did was discover that all sugars contain a small amount of a naturally occurring substance that inhibits the enzyme alpha glucosidase which is what digests complex sugars into glucose.

They then went on to discover that corn syrup has about three times as much of this alpha glucosidase inhibiting substance as do regular sugars. Which must be why when we eat corn syrup we see no blood sugar rise at all. Oh? We do see a rise? A big one. You're kidding! Wow! Someone needs to alert the UMASS scientists to this fact at once.

Because that's the huge flaw here. Before suggesting that their sugars could "manage Type 2 diabetes" (their wording) they should have fed some of these sugars to people with diabetes and seen what happened to their blood sugars when they ate them, which is that they rose higher than they would with any other food you could possibly feed them except pure glucose.

But what about the supposed health benefit of those antioxidants in the brown sugar? Well, if the only damage high blood sugar did to our bodies was to cause oxidation, perhaps a sugar with added antioxidants would be marginally helpful to people with diabetes.

But it isn't oxidation that causes neuropathy. It is glycation-- the bonding of glucose to other proteins, like, say the ones in your capillaries and nerves. Ditto with your eyes and kidneys. It isn't oxidation that makes you go blind or puts you on dialysis. It is a whole complex series of things that happen when your tiny capillaries get plugged up with glucose molecules. And when you eat any pure sugar be it date sugar or brown sugar it turns into glucose within minutes. Lots of it. And it damages your organs. And the part that doesn't turn into glucose, well folks it turns into fructose which goes directly to your liver where it turns into body fat.

Suggesting people with diabetes eat some particular sugar for its health benefits is like suggesting that people smoke cigarettes with carotene soaked cigarette papers. And just as ethical.

Shame on these UMASS researchers. A year ago they were promoting sugar filled blueberry soy yogurt as health food since it contained some minute amount of some substance similar to that found in blood pressure pills--without ever measuring its impact on the actual blood pressure of people who ate it. Now they are telling us to medicate ourself with brown sugar and corn syrup.

And sadly because of the venal promotion of this finding, people are going to eat more brown sugar and get more complications. There are real consequences to pursuing profit at the expense of other people's health. I don't know how the people who put out this kind of misinformation live with themselves. But they do. It is amazing what people will do to earn a buck.

NOTE: I have heard from Dr. Kalindas and he assures me that he does not take food industry funding. He also was not happy about the way his research was described in the press release that was reported in so many newspapers. I appreciated his response and his desire to be helpful to people with diabetes. I also get the impression he may not realize how much corporate money has gone into promoting the idea of "healthy whole grains" as an alternative to low carb diets, and how much of that money comes from the big grain companies. It is probably due to the amount of promotion that the grain interests have done to sell the idea of the Glycemic Index that caused the story to get so much press exposure.

It is interesting that the journal article published in the prestigious journal D. Res. Clin. Prac.--the study that tested the blood sugar of people with diabetes who ate whole grain bread and found that it raised blood sugar exactly as much as white bread did--did NOT get any press exposure. To my mind that was probably the single most practical piece of diabetes research published this year.

July 18, 2008

For many of us it doesn't make that big a difference. We know what we have to do, we know what prescriptions we need to get to do it, and our doctor is just a handy helper who gives us the tools we need to maintain control.

But every now and then I hear from someone who is doing everything right and getting terrible results. They are eating low carb and seeing blood sugars over 200 mg/dl. They are injecting heroic amounts of insulin with a low carb intake and still seeing blood sugars over 180 mg/dl. Their weight is out of control, though they are eating the right number of carefully counted calories and are exercising. And their doctors don't have a clue what is going on.

That is where having a mediocre doctor can really hurt you. Mediocre doctors suggest weight loss surgery to people whose real problem is thyroid disease or Cushings. They tell people who can't get control with diet and oral drugs that living with an 8.5% A1c is preferable to using insulin because insulin will make them gain weight. Or--and I have been hearing this a lot lately--they tell people that there is no reason to treat "pre-diabetes" even when these people are thin and have blood sugars that are rising swiftly and when they have a strong family history of diabetes and autoimmune disease.

If you find yourself dealing with a blood sugar issue that is not responding to the standard treatments that work for 80% of all people with Type 2 Diabetes--that is: cutting way down on carbs, exercising, and using a carefully selected oral drug and/or insulin--don't let a mediocre doctor ruin your health.

Unusual results require that you call on the services of a brilliant, top notch doctor. These doctors are rarely found practicing in small towns and suburbs. They are rarely found practicing out of community hospitals. The very best doctors, like the very best professionals in all fields, gravitate towards institutions filled with other brilliant leaders in their field where they can participate in cutting edge research and make names for themselves.

In short, you'll find these doctors at hospitals associated with top notch universities--the so-called Teaching Hospitals. They hold appointments as Professors of Medicine at top schools like Harvard, Stanford, or the University of Chicago. They teach, write, and publish research.

Because they practice at medical centers where other doctors refer their most difficult cases, they are likely to have seen lots of people with unusual, difficult to diagnose conditions. That means that when you show up with one of these conditions, they are far more likely to recognize it.

That is why when you have something unusual going on, these are the folks you need to see. Because if what your doctor has called "garden variety Type 2 Diabetes" is not responding to the treatments that normalize Type 2, it is possible you don't have Type 2 diabetes at all.

You may have early Type 1--in which case early intervention may make life-long control far easier because you may be able to preserve some of your beta cells. You may have an adrenal tumor which causes diabetes as a side effect of uncontrolled cortisol secretion. You may have undiagnosed thyroid disease. You may have pancreatic cancer. You may have any number of other unusual conditions that only a endocrine specialist would know about--conditions that have high blood sugar as a symptom along with other symptoms which point to another disease.

Even if you really have some form of Type 2 Diabetes, it may be an unusual form that requires a different treatment from whatever expensive drug or device the drug reps are pushing on your family doctor this month. And to find that treatment you need to see someone who graduated at the top of their class and who has devoted their career to keeping up with the latest in the field.

Think of it this way: You can take your Honda to Joe's Garage when you need a brake job, but you wouldn't take your Lamborghini there.

I don't know why it is, but when I suggest seeing these specialists, a lot of people give me long arguments about why they can't. Often it boils down to the fact that they are afraid of wounding the feelings of their nice, friendly family doctor--the same doctor who has been unable to diagnose or treat a condition that is worsening by the week.

At other times they fear that their insurance won't cover such a visit, though it often turns out they have not done the checking to find out if that is true. In many cases, the services of the specialists associated with a top university are covered just as fully as those of the guy down the street whose last formal training in diabetes care took place in 1983 when he completed his residency.

In other cases, you will have to petition your insurer to see the specialist, but you can do this via an appeals process. Worst case, if you know you need specialist services, you may have to switch insurance plans to one that has broader coverage or lets you go out of plan with a higher copay.

If you don't have insurance, it may come as a surprise to learn that the true experts aren't any more expensive to see than the piker down the street, and it is possible that the teaching hospital's social service department can help you get treatment if you can't afford to see the doctor and have evidence of a serious medical condition needing care.

In any case, the cost to you of ignoring the symptoms of a serious medical condition will be far higher over the long term than the costs of seeing someone who can sort out what is going on and get you the correct treatment.

Here's a check list to consult in making the decision of whether or not you need to see a true specialist practicing out of a top medical school-associated Teaching Hospital:

1. You have cut your carbs to no more than 15 per meal, but even with oral drugs and insulin you still see blood sugars well over 140 mg/dl at every meal.

2. Your weight is dropping dramatically even though you are eating what should be enough calories for your age, gender, and size.

3. Your weight is rising dramatically though you are eating carefully measured portions of food which you have been logging conscientiously.

4. Your blood sugar control has been deteriorating very quickly over a period of several months despite your limiting carbs, taking oral drugs, and exercising--especially if you have a family history of autoimmune disease or Type 1 diabetes.

5. Your normal child has abnormal blood sugars--fasting over 100 mg/dl and post meal numbers over 140 mg/dl at 2 hours but your family doctor tells you that "pre-diabetes" doesn't require any treatment. If your child is not obese, it is even more critical that you get to a true specialist. If there is any history of autoimmune disease in your extended family and you see your child's blood sugar rising from month to month you MUST see such a specialist--the faster, the better. There are research programs going on now exploring options for preventing Type 1 diabetes and your child may qualify for them. Only a specialist at a top Teaching Hospital may even be aware of these programs. Early intervention can make a huge difference in your chlid's long term ability to maintain normal blood sugars.

You can help ensure that you get the most out of a visit to a true specialist if you prepare for the appointment in advance. For two weeks before the appointment, carefully log what you (or your child) ate at each meal and what blood sugar tests showed at 1 or 2 hours after eating. Note fasting blood sugars. Note daily weights if weight control is an issue. Bring copies of your lab work. Do not depend on your doctor to forward them. Often their staff forgets. You have a right to copies of all your lab work, though you may have to fax permission to the lab to release the results to you, or even have to visit the lab to obtain your copies. Whatever it takes, do it. If the specialist cannot see your previous lab work the appointment may be a waste of time.

Bottom line: If something strange is going on with your body, you need to see the very best doctor and the very best doctors practice out of the very best medical school hospitals.

July 16, 2008

Though your doctor and dentist probably never mentioned this to you, there is strong evidence that gum disease may be either causing or worsening your diabetes.

Dr. Bernstein first wrote about how gum disease can raise blood sugars dramatically in the late 1990s in his first edition of Dr. Bernstein's Diabetes Solution . He recommended aggressive treatment of oral infections to lower blood sugar.

Now analysis of NHANES I data collected in the 1970s backs up the truth of his advice. A study of data collected about 9,296 nondiabetic male and female National Health and Nutrition Examination Survey (NHANES I) participants aged 25–74 years who completed a baseline dental examination (1971–1976) and had at least one follow-up evaluation (1982–1992) has shown a strong link between a diagnosis of gum disease and the subsequent development of diabetes. The study, published in the July issue of Diabetes Care, is:

The presence of any infection in the body can raise blood sugars, so it is possible that a gum infection might push an otherwise pre-diabetic blood sugar into the diabetic range. Once blood sugars reach that diabetic range they are high enough to damage the beta cells, causing further blood sugar deterioration.

Gum disease has also been associated with elevated CRP--a measure of overall inflammation in the body which also correlates with a higher risk of heart disease. This should be is very important to people with diabets since heart disease is beginning to look very much like an inflammatory disease. If you have not had your CRP measured, ask for it to be tested at your next doctor's appointment. If you have an abnormally high CRP you are much more likely to have inflammed arteries and may be one of the few people who benefit from the antiinflammatory effects of statin drugs. (People without elevated CRP are not likely to get any benefit from statins as their sole proven effect against heart disease seems to be that they reduce inflammation in the arteries.)

Dr. Bernstein explains that gum disease may also be the effect, not necessarily the cause, of high blood sugars. Given the very high blood sugars that were required for doctors to diagnose diabetes in the 1970s, it is very possible that many of the people with gum disease considered "nondiabetic" in this NHANES I study actually had undiagnosed diabetes.

More importantly, Dr. Bernstein argues that treating gum disease or any other dental infection can lower blood sugars significantly. He recommends the long-term use of antibiotics to treat stubborn oral infections.

If you have been taking a relaxed approach to early signs of gum disease as many of us do, and treating it only with infrequent cleanings and scalings, this finding should motivate you to demand more aggressive treatment from your dentist. For starters, life is a lot more fun when you have teeth. Taking a relaxed approach to gum disease is the number one way to guarantee that you won't have those teeth by the time you reach your 60s.

If you are a younger person, you can do a lot to prevent the development of gum disease by flossing your teeth daily. It's a simple thing to do but very effective. I started flossing in my early 30s after seeing a coworker lose all his teeth in his mid-40s. Almost 30 years later, my dentist can find no evidence of gum disease in my mouth, despite my going through many years of undiagnosed diabetes. Flossing is far more effective than brushing in preventing both cavities and gum disease. Make it a daily habit and your blood sugars will thank you!

Dr. Bernstein also suggests that if you see a sudden spike in your blood sugar that lasts for more than a few days can't be explained by any other cause, head to your dentist to make sure you don't have a gum or tooth infection.

July 14, 2008

UPDATE (April 2, 2013): Before you take Byetta, Victoza, Onglyza, or Januvia please read about the new research that shows that they, and probably all incretin drugs, cause severely abnormal cell growth in the pancreas and precancerous tumors. You'll find that information HERE.

Original Post:

As a good example of what a poor job the medical press does in telling us the truth about drug company activity, when an alert reader sent me the link to the actual VT state report on drug company expenditures, I learned that in Vermont, Januvia is the third most heavily marketed drug in terms of drug company money spent promoting it. In fact, it is the single most heavily promoted drug for a medical condition. The two other most heavily promoted drugs were the psychiatric drugs being pushed on kids.

Yet not a single piece of reporting that discussed the Vermont report mentioned Januvia! More importantly, buried in the report, and again, not reported in the media, was the fact that the third group of doctors who were paid the most by the drug companies were family doctors--specialists in internal medicine--who received an average of $13,209 apiece from drug companies.

Not so surprisingly, it is those internists who are writing the bulk of the prescriptions for Januvia--internists who, by the way, do not have a clue what this extremely dangerous drug does, besides lowering blood sugar.

In fact, Januvia lowers blood sugar by impeding the action of an enzyme, DPP-4, which is an essential part of the immune systems mechanism for destroying cells that have become cancerous. In particular, DPP-4 is heavily involved in destroying metatastic melanocytes which cause melanoma, it also is involved in controlling the cancerous cells that cause ovarian and prostate cancer. I have been pointing this out for more than a year.

Recently I received an email from a reader who pointed me to a letter from a physician, Dr. Mark R. Goldstein to Annals of Internal Medicine on the subject of how DPP-4 inhibitors may promote cancer. You can read that letter HERE

I contacted Dr. Goldstein and he wrote me back, "My interpretation and analysis of the New Drug Application submitted to the FDA for Januvia (reference # 8 in my letter), is that Januvia promoted 10 cancers for every 1000 subjects treated for a year. Compared to placebo, the annualized cancer incidence increased from 9 to 19 of 1000 subjects treated for a year.

"There may be 3 million taking Januvia at this time and it is highly advertised. Extrapolating the data from the New Drug Application suggests that this has the potential to cause 30,000 extra cancers each year in the US. Since there are about 1.5 million new cases of cancer each year in this country, 30,000 more doesn't make much of a "blip" on the radar screen."

It is nothing more than "a blip" and that means the drug companies know that the connection of their drug to cancers is not likely to show up, since family doctors won't even connect new cancers in their patients with a diabetes drug they prescribed two or three years before and the overburdened FDA doesn't track cancer incidence in people prescribed new drugs.

But think of the toll paid by the 30,000 people who may die because their family doctor prescribed this new, not very effective, but highly dangerous drug after being paid all those thousands of dollars by drug companies and being targeted by the many millions of dollars those drug companies spend promoting those drugs.

The whole Vermont report is available HERE. As you read it remember that Vermont is a tiny state with very few doctors. The drug company doctor payoffs documented here are only a tiny fraction of those going on in larger states with more population and more doctors. For that matter, they are a small number of the drug company doctor payoffs in Vermont, since they only had to list (by specialty only) the top 100 doctors.

And please, if you or someone you love is freshly diagnosed with diabetes and put on Januvia, ask your family doctor if they are aware of the research connecting DPP-4 inhibition with cancer and direct them to Dr. Goldstein's article with its cites of the research literature. And if the doctor still insists Januvia is safe, ask them how much they received from Merck the past year. And how many visits they get every month from Merck sales reps.

Week in and week out we read articles about obese mice and rats with "type 2 diabetes" claiming that this or that treatment cures them and suggesting that a similar cure for people is just around the corner.

Nothing could be more wrong.

The usual reason for urging caution with rodent studies is that rodents have very different pancreatic function than do primates. In fact, much about their metabolisms is very different from ours.

But the reason that rodent studies are usually a dead end goes much further than that. The real reason is that while these rat and mouse "models" for Type 2 diabetes have elevated blood sugars and the OB mouse is, indeed, very fat, the genetic flaws that cause the high blood sugars and obesity in these rodents are not flaws in the genes that have been connected with diabetes in human populations.

The OB mouse, for example, is leptin deficient. Only a few families of humans world wide are obese because of leptin deficiency. Still, researchers continue to use OB mice to study obesity, though the underlying differences in metabolism of the OB mouse and the obese human are as different as those of a person who is coughing because they have TB and a person coughing because they have COPD.

The rat model for type 2 diabetes is the GK Wistar rat. Studies of which genes are defective in these rats turned up genes researchers named Niddm1 and Niddm2, which sound impressive until you note that neither of these gene mutations are commonly found in humans with Type 2. In fact, the only way that scientists have been able to study any of the gene abnormalities that are known to be common in humans is to breed transgenic mice that have had human genes inserted into them! (You can read about one such experiment HERE).

Nevertheless, nutrition researchers and researchers investigating all kinds of diabetes related issues continue to experiment on the common mouse and rat models for diabetes--the ones with defective genes not found in humans that are handy for researchers because they breed true.

And they continue to come up with findings that have little or no relevance to humans.

Even the argument that these rodent models are useful for studying the effects of high blood sugar on the organism are suspect because the organism in question is so metabolically different from humans. And because we don't know how much of what we are seeing is the result of the high blood sugar or of some other effect of the grossly abnormal non-human genes that give us a rat or mouse that will breed reliably diabetic.

This doesn't mean everything learned from rats and mice is completely irrelevant, only that most of it is.

If you understand this you'll be less likely to get excited when you see yet another highly touted article in the medical press about how diabetes has once again been cured in some lucky rodent--or perhaps not so lucky rodent, as they are "sacrificed" and dissected as part of the experiment.

Even if diabetes really were cured in a mouse with a transgenic human diabetes gene, your celebration should be muted. There are hundreds of unrelated gene defects that cause diabetes in humans.

And any study that suggests that one nutrient or diet cures diabetes in rodents and hence you should be eating it--well, I have enough respect for your intelligence not to have to spell out just how silly that is. Especially since rodents have evolved over many millions of years to live on high carb seed-based diets, unlike humans.

July 13, 2008

I first posted the following entry on the Low Carb Friends bbs. Quite a lot of people wrote that they found it helpful, so I thought I'd reprint it here:

Looking at everyone's weight loss stats--starting/current/goal--my own included--has been making me think deeply about a phenomenon that I've observed happen a lot over my decade of hanging out on low carb diet discussion groups.

Almost everyone who sticks with the diet loses a significant amount of weight.

Almost no one gets to their stated goal.

Most of us stall out at a weight considerably higher than our goal and when we do, over time, we end up feeling frustrated, lose the motivation to stick with our diets, and all too often end up getting into eating habits that put the weight back on us.

This isn't because anything is wrong with us. It is exactly what every major study of every diet ever tested shows happens to most dieters.

But our strong, negative psychological reaction to not getting to goal undermines the good of what we can achieve with weight loss.

I think we need to realize how dangerous this frustration is. When someone posts about a stall, give suggestions, of course, but also remind people of what they have already achieved. Celebrate that 20, 30, 40 or 50 pounds they have lost. Because if the focus stays on the stall too long, those pounds will be coming back.

Think of it this way: Maintenance starts the day you lose 3 pounds of fat (i.e. not the water we all lose when we go into ketosis.) Maintenance is the most important part of dieting. Start celebrating not pounds to goal but DAYS IN MAINTENANCE--maintenance of the weight loss you have already achieved.

I've managed to lose a whopping 2 real lbs over 6 weeks of ridiculously stringent, book perfect low carb dieting. Frustrating? YES. But I also am in YEAR SIX of maintaining my original weight loss. And I weigh 26 lbs less than I did ten years ago.

Will I get to my new weight goal? (Which mostly means getting the flab off my tummy that got put on during my two months of using Lantus). Maybe. Maybe not.

Will I maintain my current weight? THAT is nonnegotiable.======

A couple other thoughts that sprang from reactions others posted to this thread:

1. Most of us seem to stall out very seriously when we've lost about 20% of our starting weight. Some of us permanently. But 20% is far more than all the studies show most people ever lose. If you can lose 20% of your starting weight, no matter what that weight might have been, you will experience health benefits. Concentrate on percentage of starting weight rather than absolute numbers and treat anything over 20% as gravy!

2. If you have been very heavy for any period of time, your body will have built a lot of bone and put on additional muscle just to help you carry that weight around. That bone and muscle does not go away when you lose weight and it can be surprisingly heavy. So no matter what you might have once weighed, if you have ever been obese, expect your final, healthy weight to be 20 or more pounds heavier than what might have been a good weight for you before the weight gain.

3. When you are dealing with both diabetes and weight issues, blood sugar control comes first. Despite all the constant repetition in the media of how dangerous obesity is, the truth is that it is not obesity per se that damages health but the high blood pressure and high blood sugar that so often accompany obesity.

In fact, what the media don't tell you is that there is something called "The obesity paradox." What that means is this: Though obese people are more likely to have heart attacks, they are also more likely to survive them!

Finally, it's worth noting that Dr. Nir Barzilai, who has been conducting a long-term study of people who live to be 100 years old reported to the media that fully one third of the centenarians he studies had been obese in their 50s!

Bottom line: Take care of your blood sugar and blood pressure first. Work on getting that 20% of starting weight off that realistically is what most people can accomplish. Celebrate your success every day. Maintenance starts the day you lose 3 lbs!

July 10, 2008

Vermont is a small state. It's largest city would be called a "Town" if it was found in any other state.

It has few hospitals and none of the huge regional medical centers found in neighboring states like Massachusetts or Connecticut. What it does have is a law that forces drug companies to reveal--in carefully cloaked terms--how much they paid to the 100 anonymous doctors who received the most money from them. The identities of these doctors are kept secret. All we learn is their specialty.

Even so, this year's report finds that drug companies paid an average of $56,944 to eleven Vermont psychiatrists. And according to the Rutland Herald--a fact that has not been reported in many news wire versions of this story--two Vermont cardiologists split over $300,000.

You would be a good candidate for psychiatric care yourself if you didn't wonder what those doctors were doing in return for that money.

For the first time this past year the Vermont law also specified that the drug companies must reveal the top ten drugs they were marketing, and to no one's surprise, half of the top ten drugs that are marketed with drug company money are used to treat psychiatric disorders--specifically depression and ADHD.

I have not been able to find the entire report online, but my guess is that the rest of the drugs that were being marketed heavily were the very expensive cholesterol drugs: Crestor, Zetia, and Vytorin. That would explain the payments to cardiologists.

Here are the questions you should be asking yourself on hearing this.

1. If drug companies are paying this much to doctors to promote drugs in a little out-of-the-way state like Vermont with a tiny population and no major medical center, what are they paying doctors in places like New York, Boston, Los Angeles and [insert your city name here]?

2. How likely is it that the figures released here were correct? The State of Vermont has a very small state government and lacks the resources it would take to audit this kind of report.

3. How much do drug companies pay your doctor to motivate them to prescribe their biggest profit makers? Did the drug reps take your doctor to a nice dinner, send them on a cruise where they put in 1/2 an hour listening to a drug presentation and then vacationed at drug company expense? Did the drug company enroll your doctor's patients into an aftermarketing "study" where the doctor was payed hundreds or thousands of dollars per patient to "enroll" each patient--which meant prescribing a drug that was paid for by the patient or the patient's insurance company?

Finally, if your doctor put you on a new, possibly dangerous and definitely expensive drug like $145/month Januvia or Janumet shortly after you were diagnosed with diabetes instead of $8/month Metformin--which is the drug that current practice recommendations say you should have been started on, you might want to ask how much payment they received last year from Merck.

If your doctor did not tell you that you can buy R insulin for $23 a month rather than analog insulin at $89 a month, you might want to know what they received from Novo-Nordisk, Adventis, or Lilly.

Finally ask yourself how unbiased you would be in your recommendations if someone was paying your $58,000 a year for, ostensibly nothing and that someone just happened to have a product out there that you could prescribe for your patients--one that cost ten times or more what competing equally effective products could do.

Pretty scary, eh?====Update June 12, 2008:

The New York Times ran an article today that has more detail about the drug company payoffs received by psychiatrists around the country and how several of them lied about the amount when asked to disclose.

A key phrase in the article leapt out to me and points to yet another cause of the childhood obesity epidemic:

"An analysis of Minnesota data by The New York Times last year found that on average, psychiatrists who received at least $5,000 from makers of newer-generation antipsychotic drugs appear to have written three times as many prescriptions to children for the drugs as psychiatrists who received less money or none. The drugs are not approved for most uses in children, who appear to be especially susceptible to the side effects, including rapid weight gain." [emphasis mine].

It's worth noting that these psychiatric drugs have been shown, in adults, to cause not only rapid weight gain but diabetes.

July 8, 2008

I have been so appalled by the recent news that the American Academy of Pediatrics is now recommending that children be put on statin drugs that I have been rendered temporarily speechless.

What part of "Statins do not prevent heart attacks in anyone but middle aged men who have already had heart attacks" don't these doctors understand?

What part of "Statins cause cognitive deficits--some of which are permanent" escaped them? "Cognitive deficits" is fancy lingo for "Makes you stupid." To give a drug that makes people stupid to an eight year old child whose brain is still developing is, simply stated, criminal. Cholesterol is used all over the brain. Lower it in the brain and that brain won't work properly. Lower it while the brain is being constructed and you have damaged a person for life.

The drug companies don't care. There are millions of fat eight year old kids out there and they are an "exciting new market." Stockholders applaud.

Obesity in children is right up there with transgendered frogs as a sign that the pollution of our environment with chemicals, plastics, and pesticides has reached the point where it is causing genetic damage. Genetic damage always shows up most clearly in offspring. To blame childhood obesity on "lifestyle" choices is absurd. Children in my youth in the 1950s ate enormous amounts of crap--ice cream every day all summer, three candy bars every time we went to the movies, pastries full of lard every day at lunch, mounds of potatoes at every meal. We did not walk miles to school every day. We rode the bus. We watched plenty of TV after our homework was done.

But in those days, if you said, "The fat boy" or "the fat girl" everyone knew who you meant because there was at most one in every class. Obesity was very rare.

The reasons why were not hard to find: We played with sheet metal toys, not ones leaching organic compounds into our skin. We drank from glass not plastic, wore clothes that had not been dosed with flame retardants, and our moms cooked our dinner on steel or aluminum pans, not cookware coated with flurine compounds (a.k.a. Teflon) that leach into our bodies and once there cannot be removed. There were not detectable amounts of estrogen and mood altering/insulin resistance-causing SSRIs in our water supply the way there are now.

Something has changed, and it is not that kids haven't been taking enough drugs. Which reminds me of the other ugly truth about what has changed with our kids--a fact that isn't getting any attention in the media. The number of kids nowadays who are on psychiatric drugs that increase insulin resistance--SSRIs and other mood and behavior changing drugs is scandalously high. Statins, in case you missed my earlier blog postalso increase insulin resistance.

If your pediatrician tells you to put your kid on a statin, find a new one, and let your former pediatrician know why you left his practice. If adults want to waste their money on expensive, dangerous, largely ineffective drugs that change surrogate markers (LDL levels) without improving health, that's one thing. To foist such a drug on a child--a drug that could damage their brain for life, is something else--something that in my humble opinion constitutes child abuse.

July 3, 2008

A study brought to my attention by this week's edition of Diabetes in Control newsletter makes it very clear that for people with symptoms of the metabolic syndrome a fasting glucose blood sugar test result of 95 mg/dl or higher should impel their physicians to order a glucose tolerance test.

What the study found in brief is this: Over a 9 year period, within a group of 46,578 members of Kaiser Permanente Northwest, 10% of those who started out with fasting plasma glucose values of 95 to 100 mg/dl ended up diagnosed as diabetic based on a fasting plasma glucose test result greater than 125 mg/dl.

In contrast, only about 3% of those with fasting blood sugars below either 85 mg/dl or 89 mg/dl were diagnosed with diabetes.

Within the group which became diabetic, other factors which increased the likelihood of becoming diabetic, in order of impact, were diagnosed cardiovascular disease, high blood pressure, smoking, high triglycerides, and elevated BMI.

Significantly, there was NO significant correlation between the levels of LDL or HDL cholesterol and the likelihood of becoming diabetic. ONLY the trigyclerides--which are a good reflection of the blood sugar level after meals, predicted oncoming diabetes.

In their conclusions the authors point out that the lack of glucose tolerance test data for this population limited the value of the study and suggest that those with fasting glucose values of 95 mg/dl and higher most probably would have tested at the prediabetic level on a glucose tolerance test. They also point out that "Among those who developed diabetes by our criteria, however, the mean hemoglobin A1c at diagnosis was more than 7%, a level that strongly suggests that abnormal glucose metabolism has been maintained for several months."

My guess is that the over 7% A1cs suggest that the glucose metabolism had been abnormal for several years--probably beginning when that fasting glucose went over 94 mg/dl.

The group in this study whose fasting blood glucose was between 90 and 94 mg/dl had an incidence of diabetes that was about 5%.

What does this mean for you if your fasting glucose is in the 90s?

It means you need to get yourself a meter and to start testing your post-meal blood sugars, one and two hours after eating, to see how high your blood sugar is rising. You don't have to do this very often. Once or twice a year is all you need to do assuming you do not see post-meal blood sugars over 125 mg/dl which seems to be the peak most truly normal people attain, very briefly, before their blood sugar drops back to their fasting level.

If you see your blood sugar rising over 140 mg/dl after meals, take it as a sign that you are very likely to have prediabetes and start taking steps to improve your blood sugar health now, when it is still relatively easy to reverse any early diabetic changes in your body and preserve your beta cells from harm.

If your fasting blood sugar is in the 90s here are some steps you can take to improve your blood sugar health.

1. Cut the carbs. Carbs are what raise blood sugar and you are probably eating a lot of junk carbs that are stressing your body and pushing you towards developing diabetes. Try cutting out the following: All non-diet sodas, fries, white bread, breakfast cereals containing more than 10 grams of carbs per serving (most people eat two or three "servings" every time they fill a bowl with cereal, large muffins (6-8 oz), large servings of pasta, etc. Cutting carbs will lower your triglycerides, the only part of your cholesterol linked with developing diabetes.

2. Exercise. If you aren't the gym rat kind, start taking a 40 minute walk four or five times a week. That has been shown to be enough to make significant improvements in your fitness without causing injury.

3. Check your meds. Many commonly prescribed medications have a side effect of causing "hyperglycemia" i.e. high blood sugar. Read the official Prescribing Information for all medications you are taking and see which ones might be contributing to your rising blood sugars. Some drugs known to raise blood sugar are HCTZ, SSRI antidepressants, Zyprexa, prednisone and other corticosteroids. There are others. If you are taking a medication that raises blood sugar, talk to your doctor about whether there are alternatives which won't put you at risk of kidney failure, blindness, increasing heart disease, and amputation--which are what can happen to you over time if you allow your blood sugar to rise unchecked.

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I was diagnosed with diabetes in 1998. Since then I've kept my A1cs in the 5.0-6.0% range using the techniques you'll find explained at The main Blood Sugar 101 Web Site, where you'll also find extensive discussion of the peer-reviewed research that backs up the statements you read here.

I've also published two books on related subjects, Blood Sugar 101: What They Don't Tell You About Diabetes, which was an Amazon Diabetes bestseller for 3 years and Diet 101: The Truth About Low Carb Diets.